The capsular complications of cataract extraction.

The author considered the following important points:(1) Anterior capsular synechia to a corneal incision (made by a keratome) after the evacuation of a traumatic cataract. This might be detached early by the use of a blunt-ended knife following a perforation of the cornea with a sharp-pointed knife, much like a tenotome.(2) The involuntary prolapse of capsule with a cataract incision.(a) The danger of this was demonstrated as the cause of glaucoma, especially if it be found necessary to divide opaque capsular membrane after the extraction.(b) The danger of sympathetic ophthalmia.Prolapse might be prevented:(a) By intracapsular extraction.(b) By extracting the lens through an intact pupil, after the use of capsule forceps, followed either by a partial or total iridectomy.(3) The treatment of opaque after-cataract.Various types of opaque capsule membrane were described.(a) Opaque lens fibres imprisoned between anterior and posterior remains of capsule.(b) Grey membrane made of new lens fibres from proliferating subcapsular cells.(c) Elschnig's cells.(d) Much thickened capsular membrane following an extensive haemorrhage into the anterior chamber occurring about the fifth day after extraction.(e) A thick membrane formed of fibrous tissue following the invasion of the coloboma of the iris after infection at the time of operation. The fibrous tissue comes from the undersurface of the conjunctival flap and causes an updrawn coloboma which is also made narrower by its contraction.When performing a capsulotomy thickened bands should be avoided and an incision made in thin capsule, parallel to thick bands.If the membrane is very thick and shows signs of being torn from its peripheral attachment when a single needle is used, then(1) Two needles may be used after the method of Bowman;(2) A Wheeler operation may be performed (Wheeler, 1939, Collected Papers, New York, 197);(3) Thick capsule may be divided by means of a Ziegler knife, as described by the author, but not in the manner described by Ziegler.The danger of performing a capsulotomy in the presence of soft lens matter was pointed out.The occasional occurrence of localized vitreous opacification at the site of a capsulotomy, even in the absence of iridocyclitis, was mentioned.